Provider Demographics
NPI:1609233980
Name:KOOCHICHING HEALTH SERVICES
Entity Type:Organization
Organization Name:KOOCHICHING HEALTH SERVICES
Other - Org Name:LITTLEFORK CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-589-4919
Mailing Address - Street 1:801 NEVADA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267-1874
Mailing Address - Country:US
Mailing Address - Phone:320-589-2004
Mailing Address - Fax:320-589-2543
Practice Address - Street 1:912 MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLEFORK
Practice Address - State:MN
Practice Address - Zip Code:56653-9357
Practice Address - Country:US
Practice Address - Phone:218-278-6634
Practice Address - Fax:218-278-6637
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. FRANCIS HEALTH SERVICES OF MORRIS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility